ObjectiveTo explore the change of expression of oxygen-regulated protein 150 (ORP150) in pancreatic injury of rats with severe acute pancreatitis. MethodsForty male Wistar rats were randomly allocated into two groups: sham operation group (SO group， n=10) and severe acute pancreatitis model group （SAP group， 3 h, 6 h， and 12 h after modeling, each time n=10）. SO group rats were only turned over the pancreas, and the SAP group rats were induced by retrogradely infusing 5% sodium taurocholate into the biliopancreatic duct. SO group rats were killed at 12 h after sham operation, and the SAP group rats were killed at 3 h, 6 h, and 12 h after modeling. Blood samples were obtained for detecting the amylase (AMY) and alanine transarninase (ALT) levels. The quantity of ascites were collected and measured. Pancreatic tissue samples were stained with hematoxylin and eosin for histopathological evaluation. Pancreatic tissue was collected to detect the expressive quantity of ORP150 mRNA by RT-PCR. ResultsThe quantity of ascites, AMY and ALT levels, and histopathological evaluation were significantly higher in SAP group than those in SO group (Plt;0.05). AMY and ALT levels, histopathological detection, and expression of ORP150 mRNA in pancreatic rats among 3 h, 6 h, and 12 h after modeling were significantly different from each other (Plt;0.05), except for ascites. The ascites were not significantly different between 3 h and 6 h after modeling (Pgt;0.05), while 12 h were significantly higher than those at 3 h and 6 h (Plt;0.05). The expression of ORP150 mRNA was low in SO group, and were rise in subgroup SAP 12 h, 6 h, and 3 h gradually. Subgroup was statistical difference (Plt;0.05). ConclusionThe expressive quantity of ORP150 mRNA is high in pancreatic tissues with SAP rats, prompting that ORP150 may play a role in pancreatic injury with SAP.
目的总结胰腺损伤诊断和治疗的经验。方法回顾性分析我科2005年12月至2010年6月期间收治的35例胰腺损伤患者的临床资料。结果男32例，女3例; 年龄11～47岁，平均29岁。损伤程度: Ⅰ、Ⅱ级20例，Ⅲ级12例，Ⅳ级2例，Ⅴ级1例。根据病史、临床症状、血清淀粉酶、腹腔穿刺液淀粉酶检测、B超、CT等诊断。4例行非手术治疗; 31例行手术治疗，其中16例行胰腺被膜切开、清创、冲洗、引流，6例行损伤胰腺远端切除，6例行近端缝合、远端空肠Roux-en-Y吻合，2例胰腺主胰管吻合放置支撑管经空肠外引流，1例胰头部严重毁损行胰十二指肠切除术。术前明确诊断24例，术中明确诊断11例。本组死亡5例，均为胰腺复合伤，其中1例肠系膜上动脉损伤合并实质脏器损伤术后24 h死亡，4例胰腺严重毁损，术前抗休克后术中探查见胰腺损伤合并2个以上脏器损伤，术后肝、肾功能衰竭，经抢救无效死亡。治愈30例。结论胰腺损伤的术前诊断率较低，围手术期应积极剖腹探查弥补术前不足，外科治疗要根据损伤分级采取个体化方案，贯彻损伤控制性外科理念，不宜盲目扩大手术。
目的 探讨闭合性胰腺损伤的诊断和合理的手术方式。 方法 对我院2005～2008年期间收治的16例闭合性胰腺损伤患者的临床资料进行回顾性分析。 结果 本组术前确诊5例，另11例在术中确诊。根据胰腺损伤的不同分级进行相应的手术治疗，手术均顺利完成。术后无一例出现胰瘘，但出现胰腺假性囊肿1例，腹腔出血1例，腹腔感染2例，死亡2例。 结论 重视胰腺损伤的早期诊断，选择合理的手术方式及时手术，加强围手术期处理，可提高胰腺损伤的救治成功率。
目的 探讨胰腺损伤患者的诊断及处理原则和方法。方法自1994~2005年11年期间我院共收治17例胰腺损伤患者，其中闭合性损伤8例，开放性损伤8例，医源性损伤1例。分析其临床特征、手术方式及手术并发症。本组全部行手术治疗，肠系膜上血管左侧的损伤以修补、胰体尾切除或加脾切除为主； 胰头及合并十二指肠的损伤以修补及胃十二指肠、空肠、胆总管等多口造瘘为主； 胰头毁损伤则行胰十二指肠切除。结果术后发生胰瘘3例，胰腺假性囊肿2例，膈下及腹腔脓肿5例。治愈16例，治愈率为94.1%； 死亡1例，死亡率为5.9%。结论胰腺损伤宜早期诊断并及时手术治疗，术中判断损伤类型、正确选择手术方式及充分的冲洗引流是治疗胰腺损伤，防止或减少并发症的关键。
目的探讨胰腺损伤的诊断和治疗方法。 方法回顾性分析16例胰腺损伤患者的临床资料。 结果胰腺损伤属Ⅰ级3例，Ⅱ级5例，Ⅲ级4例，Ⅳ级3例，Ⅴ级1例；系单纯胰腺损伤3例，合并其他器官损伤13例。术前确诊为胰腺损伤者9例，另7例分别诊断为：脾破裂1例，肝破裂1例，开放性腹部损伤2例，空腔脏器穿孔、弥漫性腹膜炎3例。8例胰腺Ⅰ～Ⅱ级损伤者行清创、缝扎止血及胰腺周围双套管引流术；4例Ⅲ级损伤者行胰体尾切除+脾切除术；3例Ⅳ级损伤者，行近端胰腺断端缝合、胰管缝扎加胰体尾空肠Roux-en-Y吻合术；对1例Ⅴ级损伤者行胰十二指肠切除术。术后发生胰瘘5例；治愈13例，死亡3例。 结论早期诊断、及时手术探查以及术中选择合理的手术方式，对降低胰腺损伤的并发症和死亡率和改善胰腺损伤的预后均十分重要。
ObjectiveTo explore the safety and feasibility of spleen-preserving distal pancreatectomy for children with distal pancreatic injures.MethodsClinical data of 10 patients with severe distal pancreatic injures in The Second Affiliated Hospital of Guilin Medical University from January 2012 to July 2017 were retrospectively analyzed. The intraoperative and postoperative situation including operation time, intraoperative blood loss, postoperative blood platelet count, and perioperative complications were observed.ResultsAll the 10 patients underwent spleen-preserving distal pancreatectomy successfully. The median operation time was 3 h (2–6 h), the median intraoperative blood loss was100 mL (50–300 mL), the postoperative blood platelet count ranged from 75×109/L to 260×109/L with the median postoperative blood platelet count was 175×109/L. Two patients suffered from pancreatic leakage, one patient suffered from subphrenic infection, and one patient suffered from pulmonary infection. All patients suffered from complication recovered after symptomatic treatments. All patients were followed up in the outpatient department, the follow-up time was 4–60 months with a median of 30 months. Reexamination of abdominal ultrasound and blood routine (every 3 months after surgery) showed that, no abnormalities in blood supply, morphology, and structure of spleen, and platelet counts fluctuated within the normal range. During the follow-up period, none of the children suffered from severe infection due to hyposplenic function.ConclusionSpleen-preserving distal pancreatectomy is a safe and effective method for children with distal pancreatic injures.
Objective To summarize the experience of surgical diagnosis and management of patients with blunt pancreatic trauma. Methods The clinical data of 15 patients with blunt pancreatic trauma who underwent surgical treatment in the Yuebei People’s Hospital from January 2019 to April 2021 were retrospectively collected. The injury causes, early diagnostic methods, surgical treatment results, and major complications of patients with blunt pancreatic trauma were analyzed. Results The causes of blunt pancreatic trauma: traffic accident injury (seven patients), falling injury (four patients), impact injury (three patients), and crush injury (one patient). Organ Injury Scale grading system of the American Association for the Surgery of Trauma grading of pancreatic trauma: grade Ⅱ (five patients), grade Ⅲ (seven patients), grade Ⅳ (two patients), and grade Ⅴ (one patient). The patients whose serum amylase value was more than four times of reference value (104 U/L) or who underwent enhanced CT were diagnosed with pancreatic trauma before operation. Two patients underwent pancreatoduodenectomy, two patients underwent removal of peripancreatic hematoma+pancreaticojejunostomy, seven patients underwent distal pancreatectomy, two patients underwent suture hemostasis of pancreas, two patients underwent clearance and drainage of pancreatic necrosis. One patient died of combined injury and bleeding. Major complications: five patients suffered from biochemical leakage, three patients suffered from grade B and one patient suffered from grade C pancreatic fistula, one patient suffered from abdominal pseudoaneurysm and hemorrhage. Conclusions The early diagnosis and grading of pancreatic injury should be combined with the history of injury, serum amylase level, and abdominal enhanced CT. Surgical intervention should be carried out as early as possible for high-grade pancreatic trauma.